Becker’s Healthcare Podcast: Dr. Anthony J. Tortolani on the Changing Landscape of Cardiac Care and Ambulatory Surgery Centers

Date: December 22, 2025
Guest: Dr. Anthony J. Tortolani, Cardiac and Thoracic Surgeon, Professor Emeritus, Weill Cornell Medical College
Host: Francesca Matthews

Overview

This episode features Dr. Anthony J. Tortolani, a renowned cardiac and thoracic surgeon and professor emeritus at Weill Cornell Medical College. Dr. Tortolani draws on his decades of experience developing and managing ambulatory surgery centers (ASCs) to analyze major trends, challenges, and opportunities within healthcare—especially as they relate to cardiac care, artificial intelligence (AI), and the evolving ASC landscape. Throughout this engaging conversation, Dr. Tortolani provides candid insights on clinical innovation, staffing shortages, equity issues in rural medicine, and the critical business pressures facing health systems.

Key Discussion Points and Insights

Dr. Tortolani’s Background and Experience

• Introduction & Career Highlights (00:31)
  • Spent career as chief of cardiothoracic surgery or department chair, mostly within the Cornell network.
  • Instrumental in building the first ASC at Northwell, converting hospital floors at NY Presbyterian for ambulatory surgery, and developing ASCs across multiple hospitals.
  • Participated in strategic planning, sometimes deciding not to build ASCs when not feasible, giving him a broad perspective.

Top Trends in Healthcare

1. Worsening Caregiver Shortages (01:48)

“The great concern about not having enough caregivers, primarily anesthesiologists, nurses and anesthesia assistants. That is a real problem that's going to get worse over the next 7 or 8, 10 years unless we increase the number of anesthesiologists for training.”
(Dr. Tortolani, 01:55)

• Highlight: This year, 1,400 U.S. medical students wanted to pursue anesthesia but there were not enough positions.
• Projection: Anticipates a gap of 5,000–6,000 anesthesiologists nationwide in a decade.
• Short-term Fix: Nurse anesthetists handling more cases with anesthesiologist oversight, especially in ASCs.

2. Decreasing Hospital Profit Margins (03:02)

“To grow hospitals you need to have a profit margin... what's happening today in medicine, with the limitations in Medicare, Medicaid and the introduction of AI into medicine... is going to increase the cost. And I don't know how we can increase costs unless we increase profit margins.”
(Dr. Tortolani, 03:10)

• Margins are essential for growth and reinvestment, not excess profit.
• Cites limited government reimbursement and rising expenses (like AI tech) as key pressure points.

3. Expansion of For-Profit Organizations in Medicine (03:34)

“The invasion of for-profit organizations into medicine whose primary concern is not patient care, but... making profit for the equity holders in that company.”
(Dr. Tortolani, 03:38)

Excitement About AI and Clinical Advances

AI’s Transformative Power (04:47–08:19)

• AI rapidly reshaping:
  • Administrative functions
  • Basic scientific research (especially at cellular and subcellular levels)
  • Clinical diagnosis and image analysis (radiology, pathology)
• Major Clinical Impact:

“AI is allowing us to make the diagnosis that much earlier, which means we don't need to do so much invasive surgery. The surgery will be less and less invasive.”
(Dr. Tortolani, 08:19)

• Moves medicine toward:

  • Generative care: classic bedside clinical care
  • Precision medicine: using cellular/subcellular data for earlier diagnosis and targeted treatment, especially in cancer and heart disease
  • Personal care: tailoring therapies to individuals, not just the diagnosis

• Connection to ASC Growth:

  • Earlier diagnosis reduces need for open surgery, drives minimally invasive procedures in ASC settings.

Outlook on Growth in Next 12 Months

Cardiology and Outpatient Trend (08:56–12:45)

• Cardiac therapeutics increasingly shifting to the outpatient/ASC setting (TAVRs, stenting, pacemakers, defibrillators, diagnostic catheters).
• More chemotherapy, GI, and pulmonary therapy done outside the hospital.
• Prediction: Fewer hospital beds needed; hospital ORs must be “backfilled” with more acute/well-suited cases.

“I think we will be filling the ACSS more and more with all sorts of therapy and diagnostic procedures.”
(Dr. Tortolani, 09:11)

• Market Dynamics:

  • Academic medical centers/hospital systems growing rapidly.
  • Standalone hospitals in underserved/poverty areas struggle to keep pace.
  • Speculates that independent hospitals may be absorbed into larger systems over time.
  • Ownership/partnership trends: physicians may become partners, not just employees, in health system ASCs.

• Profit Margin Warning:

“Their profit margin is being low, really reduced. And that's a real concern... They take their profit and build. They don't put it in their pocket. They build inventory care centers and they build cancer perfusion centers and things like that. So I think they're doing the right thing. But how to do it is going to take a lot of cooperation.”
(Dr. Tortolani, 11:41)

• Leadership Needs: Coordination between strategic and tactical planners is vital for success.

Persistent Gaps in Rural and Underserved Areas

Barriers to Cardiology and Quality Care (13:04)

“If you're in a rural community, all the things we just talked about does not very much reach the people. Our patients in rural communities in 50% of the rural counties in this country don't have a cardiologist... The level of care of those patients is not the same as the level of care in the major medical centers, but not even close, for obvious reasons.”
(Dr. Tortolani, 13:04, 13:38)

• 50% of rural U.S. counties lack any cardiologist; travel times can exceed 45 minutes.
• Financial losses at safety-net hospitals—sometimes losing over $100 million/year—impede their ability to deliver high-quality care.

Memorable Quotes and Moments

• On AI’s Clinical Promise:

“AI is allowing us to make the diagnosis that much earlier, which means we don't need to do so much invasive surgery. The surgery will be less and less invasive.”
(Dr. Tortolani, 08:19)

• On Systemic Change:

“We're in tremendous change in medicine. And my biggest concern is what I hear. The major successful hospital systems... their profit margin is being low, really reduced. And that's a real concern to me because they take their profit and build.”
(Dr. Tortolani, 11:29)

• On Equity:

“It's very hard to get those people the kind of care that other people get. It's not equal, definitely.”
(Dr. Tortolani, 13:53)

• On Optimism Despite Challenges:

“I don't mean to be pessimistic, because I look at the advances and I say, my God, it's unbelievable. It's truly unbelievable what's happening, I think how to coordinate it and do it right so everybody benefits by it. That's going to take a lot of thinking and planning, but we certainly are making advances on the scientific side of it. Without a doubt. Absolutely.”
(Dr. Tortolani, 14:52)

Timestamps for Important Segments

• 00:31 – Dr. Tortolani describes his background in surgery and ASC development
• 01:48 – Three major healthcare trends: workforce shortages, hospital profit margin decline, rise of for-profit organizations
• 04:47 – Excitement about AI’s administrative and clinical impact
• 08:19 – AI meaning earlier, less invasive diagnoses
• 08:56 – Growing cardiac & therapeutic procedures in ASCs; shifting care models
• 13:04 – Rural and underserved communities—persistent gaps in access and care
• 14:52 – Staying optimistic about progress in the face of systemic challenges

Conclusion

Dr. Tortolani’s conversation is both a warning and a celebration. He underscores serious staffing shortages, economic headwinds, and access inequities, while passionately highlighting science and technology advances—especially AI’s revolutionary effects on research, diagnosis, and patient-centered care. The landscape for ambulatory cardiac care and ASCs is evolving rapidly, but ensuring equitable access and sustainable growth will require smart, coordinated planning and continued innovation.